You don’t have to look far these days to stumble across alternative medicine. Whether it’s homoeopathy at the pharmacy, the osteopath in the high street or acupuncture at the GP surgery, alternative medicine is everywhere and the sheer number of claims and therapies can be bewildering.

It’s been estimated that there were five million consultations to an alternative practitioner in the UK in 1999. Currently around 58% of GPs use some form of alternative therapy and in 2002 there were over £125 million spent on herbs, homoeopathy and aromatherapy in the UK.

One problem is definition. The BMA defines alternative medicine as:

Any medical system based on a theory of disease or method of treatment other than the orthodox science of medicine as taught in medical schools. [2]

This is helpful, but it does have some shortcomings. Firstly, it’s a diagnosis of exclusion; it tells you what alternative medicine is not, but doesn’t define what it is. Secondly, it can change with time and place - osteopathy is part of conventional healthcare in the USA, but less so in the UK. Furthermore, as alternative medicine grows in popularity, some teaching on it will increasingly be given in medical schools.

Another problem is what to call it. We often hear of complementary and alternative medicine, but this is a contradiction, as complementary implies going hand in hand with orthodox medicine, whilst alternative implies standing in opposition.

A common thread

Any list of alternative therapies will pull together an amazing diversity of therapies that may seem to have little in common at first sight – from acupuncture and aromatherapy to reflexology and yoga. All have their own ideas about how to diagnose illness and maintain health, but there is one concept in particular that runs through many therapies.

The idea of life force or vital energy is common. This is claimed to be a non-physical energy that passes through the body. When flowing freely it enables health, but blockage or imbalance leads to disease of various kinds. Treatment aims to manipulate that energy by different means. In acupuncture, with needles; in aromatherapy, with aromatic oils and in reflexology, through foot massage.

The life force concept often comes from an eastern religious worldview. Traditional acupuncture comes from Taoism and calls the force Chi. Yoga and transcendental meditation originate in Hinduism and call it prana. Amongst the more western therapies, homoeopathy calls it vital energy whilst chiropractic calls it innate intelligence.

This is from a leaflet on a therapy called Chakra Essences:

Our physical body rejuvenates and energises itself not just with food and breath but also by receiving universal energy or ‘prana’ from the air around us. It does this by exchanging energy at the chakras or energy centres of the body. So, fresh energy is drawn into the body through the auric field via the chakra points. Toxins, negative thought patterns and emotions leave the physical body through the chakras. Chakras become blocked by long held negative states and pollution etc, which eventually can lead to physical disease.

Suffice it to say that any therapy that talks about this concept of energy should make us instantly suspicious.

Reasons for popularity

There are several factors involved in the rise of alternative medicine.

1. Changes in the western worldview

There has been a rise in acceptance of pantheistic thinking and concepts of life force, especially with the popularity of the New Age. Furthermore there’s been growth in what we might call postmodern whateverism, where people are more interested in outcomes and less in the details – if something works, who cares if the underlying theory is completely contradictory to something else that we believe?

2. The failings of orthodox medicine

Conventional medicine has made huge strides in recent decades, with surgery, antibiotics, vaccination, chemotherapy and many other weapons in the therapeutic arsenal. Yet for all this we have little to offer for such widespread conditions as back pain and the common cold. Add to this the fact that many people seeing their GP don’t have a defined organic illness, and it’s no wonder that they don’t respond well to standard therapies.

3. Medical arrogance

We’ve all known doctors who will not admit failure. Many orthodox treatments are of doubtful value or can have significant side-effects. The medical system can easily be weighted with the power on the side of the doctor, and patients are understandably frustrated by doctors who don’t validate their experiences, or explain the diagnosis and treatment in ways they can understand.

4. Loss of a whole-person perspective

With our detailed understanding of anatomy, physiology and pharmacology, it’s easy to focus on individual systems and organs, whilst missing the person they are in. We’ve all been on the surgical ward round and referred to the appendix in bed three! In gaining in the science of medicine, we have often lost in the art, whereas alternative practitioners can be just the opposite – using time, touch and listening to build up trust with a patient.

5. Costs of high-tech medicine

The latest treatments can cost big time. I was surprised to realise recently that the sumatriptan I prescribed for a migraine cost more than £5 a tablet, and that’s nothing compared to the costs of some treatments. In contrast, many alternative therapies cost only the therapist’s time – a medical manager’s dream!

6. Consumer demand

In our culture we tend to idolise our health and will try anything if there’s a chance it may work. Patients will pay for therapies that promise to fix the ills that conventional medicine cannot remedy, so there is always room for more therapies and more practitioners!

Ancient + natural = good?

Many people think that if a therapy is both ancient and natural it must be good. This combination is seen as a kind of quality control that means a therapy is tested, reliable and free of major side-effects.

There certainly were lots of treatments in the ancient world. Over 16,000 different Chinese preparations alone have been listed. But the trouble is that many ancient remedies were either useless or harmful. One example is blood-letting, which was widely practised for a range of conditions, yet leads to dehydration and anaemia and solves little.

Galen was a 2nd century Greco-Roman physician whose writings were authoritative for centuries. He promoted the idea of the four humours, which were blood (from the liver), phlegm (from the lungs), yellow bile (from the gall bladder) and black bile (from the spleen). He claimed that balance in these promoted health, whilst imbalance caused disease. This wrong theory led to such harmful practices as bloodletting and purging. It is a prime example of how a therapy can be both ancient and natural but totally wrong and quite harmful!

In fact, it was from a mass of such baseless theories that modern medicine arose, where careful study and observation led to the accumulation of evidence about normal function, the nature of pathology and rational options for treatment. Huge advances have been made and much suffering relieved. A wealth of reliable evidence has been accumulated. Yet there is still a massive burden of chronic disease, such as asthma, diabetes and arthritis. We have tended to place too much emphasis on cure but too little on care, focussing on the pathology more than the person.

In contrast, alternative medicine is strong on understanding and listening, tailoring the therapy to the person. It has majored on care and viewing patients as whole people. Yet it has very often been sparse when it comes to hard evidence of effectiveness, based on theories that are fantastic or false.

Why might it seem to work?

If evidence is often lacking for much alternative medicine, why do amazing stories abound of what it has done for individual patients? I’ll look at this briefly under six headings:

1. Genuine therapeutic effect

Althought there is often more anecdote than evidence, there may well be a genuine therapeutic effect in some cases. One obvious example is herbal medicine. Many prescription drugs have natural origins and it’s clear that the natural world holds more treasures. There could be many compounds stumbled upon by the ancients that really are effective. If that is so, it is essential that they can be isolated, tested to find out their efficacy and side-effect profile, and given in the right dose. The effect may be quite separate from the underlying theory. An effective herbal compound may act on a specific receptor to make a cellular change – it does not manipulate your Chi energy!

2. The placebo effect

I’m convinced that this is a major factor in much alternative medicine. The fact is that the placebo effect is present in all medicine, whether conventional or alternative. The word comes from Latin meaning ‘to please’ and simply means that a patient may feel benefit from a treatment that has no specific action on their condition. A proportion of patients given completely inert tablets will report symptomatic improvement in pretty much all conditions, even though the tablets themselves have done nothing.

This is why conventional medicine uses placebo-controlled trials, to eliminate the effects of placebo and find the specific effects of the treatment. Often it’s only when large, well-controlled trials are done that we can tell if a therapy really has any effect beyond that of placebo. This is why many of the small, poorly-controlled trials of alternative therapies just can’t tell us if there is really any effect. Some medical historians have summarised the entire history of medicine up until recent decades as being the history of the placebo effect![3]

The placebo effect can be increased by a number of factors, such as a patient having confidence in the therapist, or sharing their worldview. Time, trust and listening will increase the placebo response, and especially so with vague, multifactorial symptoms that are stress induced or psychosomatic.

Using placebo is not necessarily wrong. All medicine has a placebo component and we should use treatments that have good evidence for their specific effect, whilst maximising the placebo response through building up the doctor-patient relationship. Michael Balint, one of the pioneers of general practice theory in the 20th century, coined the term ‘the doctor as drug’,[4] indicating that our relationship with the patient has a therapeutic effect in itself.

Some would say that the important factor is how the patient feels, not how the treatment works, but this runs the risk of deceiving them and returning to an age where objective evidence means very little, which is exactly what is happening with the rise of alternative medicine.

3. Concurrent use of other therapies

Many patients use alternative therapies alongside conventional medicine. If they improve, who is to say where the effect came from? If they trust their homoeopath more than their doctor, they may naturally attribute the improvement to the alternative therapy.

4. Spontaneous remissions

Many diseases are self-limiting, especially viral infections. It may simply be that the illness has run its course, quite apart from the therapy that was being used.

One of the problems in determining causality is this: if B followed A, did A cause B? If a patient used a particular therapy and felt better soon after, does that prove that the therapy caused the improvement? It’s often tempting to make associations without evidence. I’m sure we’ve all known variations on the old lady with a cardiac arrhythmia who tells us that her heart’s never been the same since she fell and banged her knee. In her mind, the fall upset her heart, but it’s far more likely that the two simply happened around the same time. It may even have been a pre-existing arrhythmia that caused her to fall in the first place! This kind of muddled thinking is exactly why we need good hard evidence to tell us the specific effect of therapies, both conventional and alternative.

5. Influence of diet and lifestyle

Many alternative therapies and practitioners place a commendable emphasis on good diet, regular exercise, rest and relaxation, stopping smoking and drinking less alcohol or coffee. These lifestyle modifications alone will produce major benefit for many conditions.

6. Demonic influence

I’ve left this until last because I don’t want us to see a demon under every chair with alternative medicine. But there can be a real spiritual danger in uncritical use of alternative therapies. This is particularly so with therapies that talk of harnessing universal energy, or using spirit guides or any form of supernatural means in diagnosis and treatment.

Sometimes this comes down to the individual therapist. Take osteopathy: most osteopaths would see themselves as using a purely manipulative therapy to treat musculoskeletal complaints. However, the founder AT Still, claimed to have psychic powers that enabled him to diagnose and treat conditions. He claimed inspiration from the Great Wisdom and hence a spiritual dimension to his therapy that was definitely not Christian.

We must also accept that some genuine healing may be demonic in nature. There is nothing to suggest that Satan cannot produce genuine healing in order to deceive. Deuteronomy 13 makes it clear that not all miracles are from God. It would be perfectly reasonable for Satan to cause genuine physical healing in some people, ensnaring them in a false way of thinking that takes them further away from considering the Christian gospel.

Assessing a specific therapy

So we’ve considered six main reasons why alternative therapies may work or seem to work. But how can we apply that practically when assessing an individual therapy? There are so many that we could always be presented with one that we know nothing about. If a friend suggests that we try Tibetan banana therapy, what do we need to consider before we get involved or recommend it to others?

1. Do the claims fit the facts?

Orthodox medicine is generally evidence-based, and becoming more so all the time as further research is done. Any new drug must undergo extensive testing to determine its efficacy, side-effect profile and interactions before it ever hits the market. Tight regulation ensures that only safe and reliable drugs are marketed, and if concerns come to light later on, drugs are withdrawn, as happened recently with COX-2 inhibitors such as rofecoxib.

This rigorous control does not exist with alternative medicine, and therapies can be marketed on the basis of a crazy theory, with little evidence for its efficacy other than anecdote and marketing techniques. We should look for good trial data and be wary of small trials with subjective outcome measures or a lack of placebo control. This invalidates the majority of studies done on most alternative therapies.

Professor Edzard Ernst from Peninsula Medical School in Exeter and Plymouth is the country’s only university chair in alternative medicine. He edits a journal called Focus on Alternative and Complementary Therapy[5] that regularly publishes good quality trial data – many of which fail to show conclusive evidence for the therapies tested.

Another excellent source is Alternative Medicine – the Christian handbook, by O’Mathuna and Larimore, available from CMF.[6] This has a huge amount of specific information on individual therapies and herbal compounds, including summarising the available trial data.

2. Is there a rational scientific basis?

The theory underlying most orthodox medicine is soundly based on careful observation and evidence. There are still mysteries – we don’t know how general anaesthetics really work, but there’s no doubt that they do, and a number of reasonable theories to explain their action. Yet many alternative therapies are based on theories that run counter to the evidence, or have a very tenuous link with it.

Take homoeopathy. We know how most drugs work: they can interact with specific receptors, block enzymes or replace missing compounds in a known metabolic pathway. The drug has to be delivered to the appropriate site and increasing the dose will increase the effect up to a point. Homoeopathy turns this on its head and tells us that having less of a drug makes it more effective, even to the point of having nothing left of the original active compound. We are told that drugs that would normally produce similar symptoms to the disease are effective in combating it (the principle of ‘like cures like’), despite the fact that one symptom may be caused by a variety of specific pathologies. This is completely against evidence and reason.

So it is essential that we examine the underlying theory to see if it makes sense or has any evidence supporting it. Granted, there may well be truth yet to be discovered out there in the mass of crazy ideas, but this should not make us switch off our brains and accept muddled thinking or contradictory logic.

3. What’s the underlying worldview?

This is a crucial point. Many therapies are based on eastern religions that run completely counter to Christianity. Others may have more western origins but the worldview of the founders may concern us, such as Dolores Krieger, one of the founders of therapeutic touch, who was a Buddhist.

We should be very wary of any talk of energy medicine or a therapy that seems to have mysterious actions that cannot be explained rationally, even more so if they openly claim to use supernatural means for diagnosis or treatment. In some cases it may be possible to separate the theory from the practice itself, such as acupuncture. In others, such as Reiki, it is not.

4. Is it medically safe?

Thankfully most alternative therapies have few potential side-effects. This could be simply because they have few specific effects beyond the placebo response. But there are certainly a few dangers to be wary of. Chiropractic neck manipulation can obstruct the vertebral artery and has rarely produced cerebral ischaemia. Unregulated herbal products could contain any number of active ingredients with side-effects and toxicities that have not been sufficiently evaluated.

Perhaps the greatest danger is from a false sense of security, so that serious organic pathology, such as cancer, may be ignored whilst a patient neglects to see their doctor in favour of balancing up their energy levels with a friendly alternative practitioner. One study in London sent researchers to 29 different health food stores with symptoms that would suggest serious pathology such as a brain tumour. 42 diverse therapies were suggested and at fewer than one store in four was the researcher advised to see a doctor.[7]

Applying the theory

Let’s now use these principles to look at two examples of well-known alternative therapies to see where they fit in.[8]

Acupuncture

This ancient Chinese therapy is based on manipulating Chi energy by inserting needles at points along meridians. There is good evidence for its use in dental pain or nausea and vomiting after surgery or chemotherapy. There is some evidence for its use in headaches, but none for its use in asthma, smoking cessation or weight loss.

There is no evidence for the existence of meridians or Chi energy. Other theories include producing endorphins, the gate theory of pain control or releasing myofascial trigger points.

Many practitioners share the original eastern religious worldview, but most western practitioners don’t and it is generally possible to separate the therapy from its original theory. It is usually safe, with occasional reports of infection or pneumothorax.

Despite eastern mystical origins, it is useful in certain kinds of pain management or with nausea and vomiting. More research is needed into method of action and we should beware many of the claims for use in other conditions.

Reiki

‘Reiki’ means ‘universal energy’ and was begun by a Zen Buddhist monk in Japan in the 19th century. It claims to channel ki energy through practitioners using spirit guides.

There is no good trial data to support its use and it has no rational basis; it is essentially a spiritual therapy entirely based on spirit guides and energy medicine. The worldview cannot be divorced from the therapy.

Although it is physically safe, spiritually it is very dangerous and Christians should avoid it like the plague!

Conclusion

We began by asking, ‘what’s the alternative?’ and in order to answer that we need to know what we are offering the alternative to. Many practitioners are simply offering an alternative to conventional medicine, but as Christians our alternative is a middle ground, an alternative to two unhelpful extremes.

On the one hand stands conventional, evidence-based medicine with its tendency to focus on the pathology and forget the person. On the other hand stands alternative medicine, with its commendable focus on the individual and preserving balance in life, but all too often a willingness to suspend critical thinking and accept baseless and contradictory theories.

Between the two should stand Christians, with a commitment to evidence-based practice and reliable therapies, but also a commitment to care for the individual, by listening, understanding, communicating truth and a genuine concern for all aspects of our patients’ lives. Now that’s an alternative that’s worth proclaiming!